The Nurse Family Partnership (NFP), a home visiting program for low-income parents expecting their first child, has been identified as a preventive intervention program that meets high evidentiary standards as a result of its being tested and shown to work in three randomized clinical trials. Based on this evidence, the NFP has been designated a model program for preventing child maltreatment, youth violence and mental illness among children and youth. The reduction of child maltreatment, youth violence (specifically, fighting and carrying of weapons among adolescents) and mental illness among children and youth are salient public health problems targeted in Healthy People 2010 Objectives. Considerable research evidence exists on the factors that influence the diffusion of health-related interventions, but relatively little is known about the factors that affect the quality of their implementation - about what happens to interventions once they have been adopted. Although staff competence is frequently identified as key to the effective implementation of innovations, how this competence is produced and sustained is poorly understood. This study proposes to identify how this learning takes place among the clinical staff for the NFP and to identify contextual factors associated with variations in learning patterns across sites. The specific aims of the study include: 1. Conduct a multiple case study of 12 NFP program sites, using a focused ethnographic approach (observation and interviews), to (a) identify and map team learning behaviors, (b) the challenges nurses experience in local program implementation and the strategies they use to manage these challenges (i.e., quality improvement learning) and (c) the intra-organizational and inter-organizational variables that influence team learning and fidelity to the NFP program model. 2. Pilot test the use of selected questionnaires/scales of organizational culture, team efficacy, team psychological safety, team leadership (developed in business settings), and a new measure of interorganizational relations developed for this study to assess their psychometric properties in the context of the public health care delivery system, the most common setting for the delivery of the NFP. 3. Compare qualitative and quantitative data to (a) propose new or refine existing measures of intraorganizational and inter-organizational variables, and (b) further elaborate and/or revise the proposed conceptual model of factors influencing the quality and fidelity of NFP program implementation to provide the foundation for future research focused on model testing. [unreadable] [unreadable]